Novel insights into determinants and prevention of atrial fibrillation progression
Atrial fibrillation (AF) is the most prevalent arrhythmia, and its prevalence is expected to continue to rise. This is alarming, since incident AF and AF progression are associated with major adverse events such as heart failure, stroke, impaired quality of life and mortality. AF is a progressive disease, usually starting with short lasting, paroxysmal self-terminating episodes, that often progresses to more frequent, non-self-terminating and longer episodes (persistent or permanent AF). The mechanisms and processes that underlie AF and AF progression are complex and not completely understood. Various mechanisms, caused by risk factors and comorbidities, such as hypertension, obesity, and diabetes, lead to atrial remodelling. Determinants of AF progression are not optimally studied. In this thesis potential new determinants for AF progression are studied. In addition to clinical factors (risk factors, electrocardiogram, echocardiography, cardiac computed tomography), blood biomarkers are also studied in search for potential determinants of AF progression. Further, AF progression is studied in a unique way by using continuous rhythm monitoring with an implantable looprecorder. This thesis also examines the effect of treatment of known risk factors and comorbidities of AF for the prevention of AF progression on short and long-term follow-up. This thesis provides insight into current treatment of risk factors and comorbidities and its impact on prevention of AF progression. Additionally, this thesis may help to better understand mechanisms and processes underlying AF progression, possibly predict which patients will have AF progression, and give the possibility of early and more aggressive treatment to prevent AF progression.